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J Am Acad Orthop Surg, Vol 11, No 5, September/October 2003, 344-354.
© 2003 the American Academy of Orthopaedic Surgeons
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Use of Physical Forces in Bone Healing

Fred R. T. Nelson, MD, Carl T. Brighton, MD, PhD, James Ryaby, PhD, Bruce J. Simon, PhD, Jason H. Nielson, MD, Dean G. Lorich, MD, Mark Bolander, MD, PhD and John Seelig, MD

Dr. Nelson is Director of Resident Education, Henry Ford Hospital, Detroit, MI. Dr. Brighton is Paul B. Magnuson Professor Emeritus of Bone and Joint Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA. Dr. Ryaby is Senior Vice President, OrthoLogic, Tempe, AZ. Dr. Simon is Director of Research, EBI, Parsippany, NJ. Dr. Nielson is Chief Resident, Department of Orthopaedic Surgery, Jacoby Medical Center, Bronx, NY. Dr. Lorich is Associate Director, Orthopaedic Trauma Surgery, Hospitals for Special Surgery, New York, NY. Dr. Bolander is Professor of Surgery, Mayo Clinic, Rochester, MN. Dr. Seelig is Doctor of Neurosurgery, San Diego, CA.

Reprint requests: Dr. Nelson, K-12, 2799 W. Grand Boulevard, Detroit, MI 48202.

During the past two decades, a number of physical modalities have been approved for the management of nonunions and delayed unions. Implantable direct current stimulation is effective in managing established nonunions of the extremities and as an adjuvant in achieving spinal fusion. Pulsed electromagnetic fields and capacitive coupling induce fields through the soft tissue, resulting in low-magnitude voltage and currents at the fracture site. Pulsed electromagnetic fields may be as effective as surgery in managing extremity nonunions. Capacitive coupling appears to be effective both in extremity nonunions and lumbar fusions. Low-intensity ultrasound has been used to speed normal fracture healing and manage delayed unions. It has recently been approved for the management of nonunions. Despite the different mechanisms for stimulating bone healing, all signals result in increased intracellular calcium, thereby leading to bone formation.




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